{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T10:02:49Z","timestamp":1784800969629,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Reliable monitoring of uterine contractility underpins the assessment of labor, the diagnosis of preterm labor, and the timing of obstetric intervention, yet routine methods measure only the mechanical consequences of contraction. External tocodynamometry and cardiotocography (CTG) are operator- and position-dependent and perform poorly with maternal obesity, detecting as few as ~54% of the contractions confirmed by an intrauterine pressure catheter, whereas surface electrohysterography (EHG) detects upward of ~94% by recording the myometrial electrical activity that drives contraction. This review examines EHG and uterine electromyography (EMG) as measurement modalities, covering their physiological origin, acquisition hardware, signal characteristics, feature extraction, and machine-learning analysis, and compares them with CTG against the intrauterine pressure catheter reference standard. Electrical approaches additionally yield predictive parameters, notably spectral peak frequency and propagation velocity, that mechanical methods cannot provide. The principal barrier to translation is methodological heterogeneity rather than physiology: differences in electrodes, filtering, feature definitions, and outcome measures preclude cross-study comparison and meta-analysis. As its central contribution, this review consolidates prior calls for standardization into a minimum reporting set for EHG studies and appraises translational readiness, identifying prospective external validation, shared datasets, explainable models, and outcome-linked trials as priorities.<\/jats:p>","DOI":"10.3390\/s26154669","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:11:26Z","timestamp":1784797886000},"page":"4669","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Electrohysterography for Uterine Contractility Monitoring: Measurement Principles, Clinical Evidence, and Reporting Recommendations"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0175-2900","authenticated-orcid":false,"given":"Gulnur","family":"Bayramli","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4005-7178","authenticated-orcid":false,"given":"Koushita Gouri Reddy","family":"Valluru","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2940-0051","authenticated-orcid":false,"given":"Ravi","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.3109\/14767058.2014.954539","article-title":"A comparison between electrical uterine monitor, tocodynamometer and intra uterine pressure catheter for uterine activity in labor","volume":"28","author":"Hadar","year":"2015","journal-title":"J. Matern Fetal Neonatal Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"66.e1","DOI":"10.1016\/j.ajog.2012.10.873","article-title":"Monitoring uterine activity during labor: A comparison of 3 methods","volume":"208","author":"Euliano","year":"2013","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"228.e1","DOI":"10.1016\/j.ajog.2010.09.024","article-title":"Noninvasive uterine electromyography for prediction of preterm delivery","volume":"204","author":"Lucovnik","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"103303","DOI":"10.1016\/j.artmed.2025.103303","article-title":"Electrohysterography in modern obstetrics: Advances in signal processing, machine learning, and clinical applications","volume":"171","author":"Barnova","year":"2026","journal-title":"Artif. Intell. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2582375","DOI":"10.1080\/14767058.2025.2582375","article-title":"Use of uterine activity to predict preterm birth by artificial intelligence assisted models: A narrative systematic review","volume":"39","author":"Chopra","year":"2026","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/0002-9378(50)90337-1","article-title":"Electrical activity of the human uterus in labor; the electrohysterograph","volume":"59","author":"Steer","year":"1950","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1016\/0002-9378(58)90828-7","article-title":"Wave forms of the electrohysterogram in pregnancy and labor","volume":"75","author":"Larks","year":"1958","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/00016347909156375","article-title":"Electromyographic observations on the human uterus during labour","volume":"90","author":"Wolfs","year":"1979","journal-title":"Acta Obstet. Gynecol. Scand. Suppl."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/BF02443874","article-title":"External recording and processing of fast electrical activity of the uterus in human parturition","volume":"22","author":"Planes","year":"1984","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1016\/0002-9378(93)90456-S","article-title":"Uterine electromyography: A critical review","volume":"169","author":"Devedeux","year":"1993","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/S0002-9378(94)70284-5","article-title":"Expression of the gap junction protein connexin-43 is increased in the human myometrium toward term and with the onset of labor","volume":"170","author":"Chow","year":"1994","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/0002-9378(81)90270-2","article-title":"Appearance of gap junctions in the myometrium of women during labor","volume":"140","author":"Garfield","year":"1981","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1109\/TBME.2009.2035440","article-title":"Modeling and identification of the electrohysterographic volume conductor by high-density electrodes","volume":"57","author":"Rabotti","year":"2010","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1111\/j.1600-0412.2012.01533.x","article-title":"Accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes","volume":"91","author":"Cohen","year":"2012","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.semcdb.2007.05.004","article-title":"Physiology and electrical activity of uterine contractions","volume":"18","author":"Garfield","year":"2007","journal-title":"Semin. Cell Dev. Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1016\/j.ajog.2011.06.071","article-title":"Electrohysterographic propagation velocity for preterm delivery prediction","volume":"205","author":"Rabotti","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ren, P., Yao, S., Li, J., Valdes-Sosa, P.A., and Kendrick, K.M. (2015). Improved Prediction of Preterm Delivery Using Empirical Mode Decomposition Analysis of Uterine Electromyography Signals. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0132116"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/j.1600-0412.2010.01031.x","article-title":"Use of uterine electromyography to diagnose term and preterm labor","volume":"90","author":"Lucovnik","year":"2011","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"109460","DOI":"10.1016\/j.cmpb.2026.109460","article-title":"Automatic detection of uterine contractions before and during labor using EHG: A systematic review","volume":"284","author":"Acquaviva","year":"2026","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1159\/000552288","article-title":"Cervical dilation classification from electrohysterography and clinical features: A machine-learning-derived digital biomarker","volume":"10","author":"Soria","year":"2026","journal-title":"Digit. Biomark."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1007\/s11517-025-03293-2","article-title":"Preterm birth prediction from electrohysterogram using multivariate empirical mode decomposition","volume":"63","author":"Cui","year":"2025","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"109417","DOI":"10.1016\/j.compbiomed.2024.109417","article-title":"Synchronization study of electrohysterography for discrimination of imminent delivery in pregnant women with threatened preterm labor","volume":"184","author":"Li","year":"2025","journal-title":"Comput. Biol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cholke, P., Mulani, U.M., Kulkarni, A.M., Joshi, D., Shahapurkar, A.G., and Gadhave, R.T. (2025). Multi-DNBiTM: Preterm labor prediction from electrohysterography signals using multi-head attention-enabled deep learning framework. Comput. Methods Biomech. Biomed. Eng., 1\u201322.","DOI":"10.1080\/10255842.2025.2602829"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ammar, H., Diab, A., Zalc, V., Istrate, D., Khalil, M., and Marque, C. (2025). Optimal electrohysterography signal preprocessing for delivery term prediction using hypergraph neural networks. 2025 47th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), IEEE.","DOI":"10.1109\/EMBC58623.2025.11254474"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Alimgozhina, A., and Akhtar, M.T. (2025). Exploring the joint effect of resampling techniques and cross-validation for preterm birth prediction. 2025 47th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), IEEE.","DOI":"10.1109\/EMBC58623.2025.11254908"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Sun, Y., Sun, T., Li, S., Wei, Y., and Niu, H. (2025). Prediction of twin preterm birth based on quadratic discriminant analysis and electrohysterogram. Comput. Methods Biomech. Biomed. Eng., 1\u201310.","DOI":"10.1080\/10255842.2025.2569818"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Barnova, K., Kahankova, R.V., Ladrova, M., and Martinek, R. (2025). Predictive obstetrics: Electrohysterogram-based detection of preterm labor. 2025 47th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), IEEE.","DOI":"10.1109\/EMBC58623.2025.11252962"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tang, J., Qi, T., Li, F., Lin, H., Ji, X., Wang, X., Lai, J., Cao, C., Zhu, L., and Fu, S. (2025). Uterine electromyography as a new predictor of extremely preterm birth: A multifactorial model integrating clinical and bioelectrical parameters. BMC Pregnancy Childbirth, 26.","DOI":"10.1186\/s12884-025-08539-3"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"02TR01","DOI":"10.1088\/1361-6579\/aaad56","article-title":"Electrohysterography in the diagnosis of preterm birth: A review","volume":"39","author":"Perales","year":"2018","journal-title":"Physiol. Meas."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.compbiomed.2015.10.005","article-title":"A nonlinear parameterization of multivariate electrohysterographical signals","volume":"67","author":"Radomski","year":"2015","journal-title":"Comput. Biol. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1111\/aogs.70187","article-title":"The effect of labor epidural analgesia on uterine activity using electrohysterography monitoring: A follow-up study","volume":"105","author":"Berben","year":"2026","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"104296","DOI":"10.1016\/j.ijoa.2024.104296","article-title":"Uterine contraction frequency after initiation of labour epidural analgesia using electrohysterography monitoring: A prospective pilot study","volume":"62","author":"Frenken","year":"2025","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3203","DOI":"10.1113\/EP093339","article-title":"Higher body-mass index modifies time-resolved maternal autonomic cardiac-uterine coupling during the first stage of human labour","volume":"111","author":"Soria","year":"2026","journal-title":"Exp. Physiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1109\/JTEHM.2025.3637293","article-title":"A comprehensive study of uterine muscle activity during the third trimester: Comparison of singleton and multiple gestations","volume":"14","author":"Meng","year":"2026","journal-title":"IEEE J. Transl. Eng. Health Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/0002-9378(65)90204-8","article-title":"Effect of Progesterone on the Electric Activity and Intrauterine Pressure of Pregnant and Parturient Rabbits","volume":"91","author":"Csapo","year":"1965","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/S0002-9378(96)70459-3","article-title":"Uterine contractility as assessed by abdominal surface recording of electromyographic activity in rats during pregnancy","volume":"174","author":"Buhimschi","year":"1996","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"eaau1428","DOI":"10.1126\/scitranslmed.aau1428","article-title":"Noninvasive high-resolution electromyometrial imaging of uterine contractions in a translational sheep model","volume":"11","author":"Wu","year":"2019","journal-title":"Sci. Transl. Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Gao, H., Wen, Z., Jiang, M., Nan, Y., and Wang, Y. (2025). Enhancing uterine contraction detection through novel EHG signal processing: A pilot study leveraging the relationship between slow and fast wave components. Front. Physiol., 16.","DOI":"10.3389\/fphys.2025.1568919"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1080\/01443615.2022.2056828","article-title":"Prediction of preterm birth using artificial intelligence: A systematic review","volume":"42","author":"Akazawa","year":"2022","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Radomski, D.S., Oscik, Z., Jozwiak, R., and Dmoch-Gajzlerska, E. (2025). A Physiologically Explainable Classifier for Labour Prediction Based on Electrohysterographical Signals. Appl. Sci., 15.","DOI":"10.3390\/app152412960"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.placenta.2026.03.007","article-title":"Insights in the (patho)physiology of uterine activity in the first 30 min after childbirth","volume":"178","author":"Berben","year":"2026","journal-title":"Placenta"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.placenta.2024.12.018","article-title":"A positive association between postpartum electrohysterography parameters and blood loss after vaginal delivery: A prospective study","volume":"160","author":"Frenken","year":"2025","journal-title":"Placenta"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Berben, P.B.Q., Frenken, M.W.E., Fransen, A.F., Delvaux, E.J.L.G., van der Ven, M., van der Hout-van der Jagt, M.B., Oei, S.G., and van Laar, J.O.E.H. (2026). Objective monitoring of postpartum uterine activity: A systematic scoping review. Front. Med., 13.","DOI":"10.3389\/fmed.2026.1703494"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"119492","DOI":"10.1016\/j.lfs.2021.119492","article-title":"Detection of acute stress by smooth muscle electromyography: A translational study on rat and human","volume":"277","author":"Pribek","year":"2021","journal-title":"Life Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.bpobgyn.2015.05.005","article-title":"Technical characteristics of current cardiotocographic monitors","volume":"30","year":"2016","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/0002-9378(85)90413-2","article-title":"Autocorrelation techniques in fetal monitoring","volume":"151","author":"Divon","year":"1985","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1111\/j.1471-0528.1985.tb01103.x","article-title":"Improvements in the registration and analysis of fetal heart rate records at the bedside","volume":"92","author":"Dawes","year":"1985","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/0002-9378(86)90067-0","article-title":"The indirectly obtained fetal heart rate: Comparison of first- and second-generation electronic fetal monitors","volume":"155","author":"Boehm","year":"1986","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Ye-Lin, Y., Alberola-Rubio, J., Prats-Boluda, G., Bueno Barrachina, J.M., Perales, A., Valero, J., Desantes, D., and Garcia-Casado, J. (2014). Non-invasive electrohysterogram recording using flexible concentric ring electrode. 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, IEEE.","DOI":"10.1109\/EMBC.2014.6944513"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"113955","DOI":"10.1016\/j.ejogrb.2025.113955","article-title":"Acceptability of intrapartum cardiotocography using wireless transabdominal fetal ECG and electrohysterography: A prospective cohort","volume":"310","author":"David","year":"2025","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/S0029-7844(97)83837-9","article-title":"Electrical activity of the human uterus during pregnancy as recorded from the abdominal surface","volume":"90","author":"Buhimschi","year":"1997","journal-title":"Obstet. Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e102901","DOI":"10.1136\/bmjopen-2025-102901","article-title":"Non-invasive electrophysiological monitoring vs conventional monitoring during labour in a tertiary obstetric care centre in the Netherlands: Study protocol (NIEM-II study)","volume":"15","author":"Berben","year":"2025","journal-title":"BMJ Open"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1038\/s41467-023-36440-0","article-title":"Noninvasive electromyometrial imaging of human uterine maturation during term labor","volume":"14","author":"Wang","year":"2023","journal-title":"Nat. Commun."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/15\/4669\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:18:39Z","timestamp":1784798319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/15\/4669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":53,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["s26154669"],"URL":"https:\/\/doi.org\/10.3390\/s26154669","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}